The Duxbury Community

Volunteer Award “2011”

The Duxbury Community Volunteer Award celebrates the

spirit of civic responsibility through community service by
honoring an exemplary Duxbury citizen or citizenry group
whose voluntary contributions of time and talent have made
a positive impact on the quality of life in our town.

Please nominate a volunteer you feel deserves to be recognized. An advisory board of civic,
educational, cultural and business leaders will review the nominations and select a nominee to be
honored as the “Duxbury Community Volunteer” for the year 2011. Finalists and their nominators will
be invited to an awards dinner at The Village at Duxbury, where all nominees will be recognized. Please
complete the information below and attach a statement describing the volunteer contributions of your
nominee and how they have impacted the community.

- Please print -
NOMINEE
Nominee’s name: _____________________________________ Telephone: _______________

Nominee’s mailing address: _____________________________________________________

(important)

NOMINATOR
Nominator’s name: ___________________________________ Telephone: _______________

Title and Organization, if appropriate: ____________________________________________

Address: __________________________________________________________________
(important)

IN 150 WORDS OR LESS ON BACK OF FORM OR INCLUDE A STATEMENT:

List the volunteer contributions this nominee has made to your organization or the community.

Describe the impact this volunteer has made on others.

Describe the lasting effect and/or ongoing involvement of the volunteer’s contribution of time
and talent.

Nominations will be accepted until 5PM on March 4, 2011.

In selecting this year’s award winner, the Advisory Board will consider the degree to which the
nominee’s contributions have positively impacted the quality of life in Duxbury, as well as the
lasting effect that the volunteer’s accomplishments may have on the town. Only voluntary (not
job related) work will be taken into consideration and the efforts must be relevant to Duxbury.

IN 150 WORDS OR LESS:

List the volunteer contributions this nominee has made to your organization or the community.
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Describe the impact this volunteer has made on others.

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Describe the lasting effect and/or ongoing involvement of the volunteer’s contribution of time
and talent.
____________________________________________________________________________________________________________

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Please return the completed nomination by 5PM on March 4, 2011 to

Duxbury Community Volunteer Award
c/o The Village at Duxbury ● 290 Kings Town Way ● Duxbury, MA 02332
Forms may be faxed to The Village at Duxbury at 781-582-2274

For questions, please contact Maureen Crowley at 781-585-2334, extension 112

Or: mcrowley@villageatduxbury.com
The Duxbury Community Volunteer Award is sponsored by the Welch Healthcare and Retirement
Group. Through this award, the Duxbury business community celebrates the spirit of civic
responsibility through community service.